Provider Demographics
NPI:1154578912
Name:WILTSIE, JOHN CALLAWAY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CALLAWAY
Last Name:WILTSIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 CORNWALL DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3423
Mailing Address - Country:US
Mailing Address - Phone:507-289-0151
Mailing Address - Fax:
Practice Address - Street 1:4554 CORNWALL DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3423
Practice Address - Country:US
Practice Address - Phone:507-289-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16135207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology